Pulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging, and Hematologic Observations.
Am J Respir Crit Care Med
; 202(5): 690-699, 2020 09 01.
Artículo
en Inglés
| MEDLINE | ID: covidwho-646801
ABSTRACT
Rationale Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology.Objectives:
To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia.Methods:
Clinical, physiologic, and laboratory data were collated. Radiologic (computed tomography (CT) pulmonary angiography [n = 39] and dual-energy CT [DECT, n = 20]) studies were evaluated observers quantified CT patterns (including the extent of abnormal lung and the presence and extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography.Measurements andResults:
In 39 consecutive patients (malefemale, 327; mean age, 53 ± 10 yr [range, 29-79 yr]; Black and minority ethnic, n = 25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead space (dynamic compliance, 33.7 ± 14.7 ml/cm H2O; Murray lung injury score, 3.14 ± 0.53; mean ventilatory ratios, 2.6 ± 0.8) with evidence of hypercoagulability and fibrinolytic "shutdown". The mean CT extent (±SD) of normally aerated lung, ground-glass opacification, and dense parenchymal opacification were 23.5 ± 16.7%, 36.3 ± 24.7%, and 42.7 ± 27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6).Conclusions:
Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.Palabras clave
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Neumonía Viral
/
Enfermedades Vasculares
/
Circulación Pulmonar
/
Infecciones por Coronavirus
/
Betacoronavirus
/
Pulmón
Tipo de estudio:
Estudios diagnósticos
/
Estudio experimental
/
Estudio observacional
/
Estudio pronóstico
Tópicos:
Covid persistente
Límite:
Adulto
/
Anciano
/
Femenino
/
Humanos
/
Masculino
/
Middle aged
Idioma:
Inglés
Revista:
Am J Respir Crit Care Med
Asunto de la revista:
Terapia intensiva
Año:
2020
Tipo del documento:
Artículo
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